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Article ; Online: Continuing Professional Development at Two Rural Hospitals in Ecuador.

Gaus, David / Conway, James / Herrera, Diego

2024 Volume 90, Issue 1, Page(s) 4

Abstract: Background: E-learning Continuing Professional Development (CPD) is an activity demonstrated to improve the quality of healthcare delivery. The CPD of medical and nursing staff in high income countries (HICs) is commonplace. CPD of administrative staff ... ...

Abstract	Background: E-learning Continuing Professional Development (CPD) is an activity demonstrated to improve the quality of healthcare delivery. The CPD of medical and nursing staff in high income countries (HICs) is commonplace. CPD of administrative staff is less common, but increasingly frequent. In low- and middle-income countries (LMICs), CPD of any kind is infrequent, particularly in rural and remote areas. Objective: The aim of this study was to describe a hospital-based e-learning CPD program for clinical and non-clinical personnel as a unique example of a successful, ongoing educational pilot, quality improvement program involving a broad cohort of employees, in a country that does not require such activities. Methods: Using the online educational platform Chamilo, e-learning modules were created for eight groups including clinical and non-clinical employees. Upon completion of each module, one to two paragraph discussions were provided for each incorrect answer submitted. Two additional chances were offered for the employee to achieve a passing score of 70%. This study reports on the first 10-month period of the program. Findings: All participants achieved the 70% passing threshold after the first or second attempt. There was 100% participation by the employees required to complete the e-learning modules. Employee feedback suggested the modules were good for continuing education, but some felt the CPD was imposed on them. Conclusion: E-learning CPD is an important and emerging element for CPD and may provide opportunities for healthcare service quality improvement as part of broader pedagogical modalities, such as conferences and directed readings, in rural and remote areas of LMICs. These pilot programs could provide important information to develop Spanish-language e-learning CPD programs across a broader region, promote collaboration with regional professional societies, and possibly contribute to the establishment of national health program CPD standards.
MeSH term(s)	Humans ; Hospitals, Rural ; Ecuador ; Education, Continuing ; Delivery of Health Care ; Learning ; Education, Medical, Continuing
Language	English
Publishing date	2024-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2821756-1
ISSN	2214-9996 ; 2214-9996
ISSN (online)	2214-9996
ISSN	2214-9996
DOI	10.5334/aogh.4175
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Article ; Online: Should all patients with polymyalgia rheumatica have a vascular ultrasound assessment?

Cowley, Sharon / Harkins, Patricia / Kirby, Colm / Conway, Richard / Kane, David J

Annals of the rheumatic diseases

2024

Abstract: There is a growing appreciation that both giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely interrelated conditions that have significant overlap in aetiology, clinical characteristics and treatment regimens. Subclinical GCA in PMR ... ...

Abstract	There is a growing appreciation that both giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely interrelated conditions that have significant overlap in aetiology, clinical characteristics and treatment regimens. Subclinical GCA in PMR is becoming increasingly recognised, and there is evolving evidence that this may be a more aggressive disease phenotype than PMR. Ultrasound (US) lends itself well as a screening tool for GCA in PMR; it is inexpensive, non-invasive, widely available, lacks ionising radiation, may be performed at the bedside and is recommended by EULAR as a first-line investigation for suspected GCA. There is insufficient evidence to currently recommend that all patients with PMR should have a US assessment for vascular involvement. However, as clinical and laboratory parameters alone do not accurately diagnose patients with subclinical GCA, we suggest that vascular US will be increasingly performed by rheumatologists in practice to identify these patients with PMR, preferably as part of larger prospective outcome studies.
Language	English
Publishing date	2024-03-29
Publishing country	England
Document type	Journal Article
ZDB-ID	7090-7
ISSN	1468-2060 ; 0003-4967
ISSN (online)	1468-2060
ISSN	0003-4967
DOI	10.1136/ard-2024-225650
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Article ; Online: A Rational Hierarchy to Capture Raw Material Attribute Variability in the Pharmaceutical Drug Product Development and Manufacturing Lifecycle.

Conway, Stephen L / Rosenberg, Kenneth J / Sotthivirat, Sutthilug / Goldfarb, David J

Journal of pharmaceutical sciences

2023 Volume 113, Issue 3, Page(s) 523–538

Abstract: Assessing the robustness of a drug product formulation and manufacturing process to variations in raw material (RM) properties is an essential aspect of pharmaceutical product development. Motivated by the need to demonstrate understanding of attribute- ... ...

Abstract	Assessing the robustness of a drug product formulation and manufacturing process to variations in raw material (RM) properties is an essential aspect of pharmaceutical product development. Motivated by the need to demonstrate understanding of attribute-performance relationships at the time of new product registration and for subsequent process maintenance, we review practices to explore RM variations. We describe limitations that can arise when active ingredients and excipients invariably undergo changes during a drug product lifecycle. Historical approaches, such as Quality-by-Design (QbD) experiments, are useful for initial evaluations but can be inefficient and cumbersome to maintain once commercial manufacturing commences. The relatively miniscule data sets accessible in product development - used to predict response to a hypothetical risk of variation - become less relevant as real-world experience of actual variability in the commercial landscape grows. Based on our observations of development and manufacturing, we instead propose a holistic framework exploiting a hierarchy of RM variability, and challenge this with common failure modes. By explicitly incorporating higher ranking RM variations as perturbations, material-conserving experiments are shown to provide powerful and enduring robustness data. Case studies illustrate how correctly contextualizing such data in formulation and process development can avoid the traps of historical QbD approaches and become valuable for evaluating changes occurring later in the drug product lifecycle.
MeSH term(s)	Technology, Pharmaceutical/methods ; Chemistry, Pharmaceutical/methods ; Excipients
Chemical Substances	Excipients
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	3151-3
ISSN	1520-6017 ; 0022-3549
ISSN (online)	1520-6017
ISSN	0022-3549
DOI	10.1016/j.xphs.2023.10.014
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Article ; Online: The Gini coefficient as a useful measure of malaria inequality among populations.

Abeles, Jonathan / Conway, David J

Malaria journal

2020 Volume 19, Issue 1, Page(s) 444

Abstract: Background: Understanding inequality in infectious disease burden requires clear and unbiased indicators. The Gini coefficient, conventionally used as a macroeconomic descriptor of inequality, is potentially useful to quantify epidemiological ... ...

Abstract	Background: Understanding inequality in infectious disease burden requires clear and unbiased indicators. The Gini coefficient, conventionally used as a macroeconomic descriptor of inequality, is potentially useful to quantify epidemiological heterogeneity. With a potential range from 0 (all populations equal) to 1 (populations having maximal differences), this coefficient is used here to show the extent and persistence of inequality of malaria infection burden at a wide variety of population levels. Methods: First, the Gini coefficient was applied to quantify variation among World Health Organization world regions for malaria and other major global health problems. Malaria heterogeneity was then measured among countries within the geographical sub-region where burden is greatest, among the major administrative divisions in several of these countries, and among selected local communities. Data were analysed from previous research studies, national surveys, and global reports, and Gini coefficients were calculated together with confidence intervals using bootstrap resampling methods. Results: Malaria showed a very high level of inequality among the world regions (Gini coefficient, G = 0.77, 95% CI 0.66-0.81), more extreme than for any of the other major global health problems compared at this level. Within the most highly endemic geographical sub-region, there was substantial inequality in estimated malaria incidence among countries of West Africa, which did not decrease between 2010 (G = 0.28, 95% CI 0.19-0.36) and 2018 (G = 0.31, 0.22-0.39). There was a high level of sub-national variation in prevalence among states within Nigeria (G = 0.30, 95% CI 0.26-0.35), contrasting with more moderate variation within Ghana (G = 0.18, 95% CI 0.12-0.25) and Sierra Leone (G = 0.17, 95% CI 0.12-0.22). There was also significant inequality in prevalence among local village communities, generally more marked during dry seasons when there was lower mean prevalence. The Gini coefficient correlated strongly with the standard coefficient of variation, which has no finite range. Conclusions: The Gini coefficient is a useful descriptor of epidemiological inequality at all population levels, with confidence intervals and interpretable bounds. Wider use of the coefficient would give broader understanding of malaria heterogeneity revealed by multiple types of studies, surveys and reports, providing more accessible insight from available data.
MeSH term(s)	Cross-Sectional Studies ; Global Health ; Health Status Disparities ; Humans ; Malaria/epidemiology ; Models, Statistical ; Population Health/statistics & numerical data ; Prevalence ; Public Health
Language	English
Publishing date	2020-12-02
Publishing country	England
Document type	Journal Article
ISSN	1475-2875
ISSN (online)	1475-2875
DOI	10.1186/s12936-020-03489-x
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Book ; Online: Macrocognition: The Science and Engineering of Sociotechnical Work Systems

Hutton, Robert J. B. / Peebles, David / Schraagen, Jan Maarten / Conway, Gareth E. / Ward, Paul / Petushek, Erich J. / Hoffman, Robert R.

2018

Abstract: The increasing complexity of work systems and changes in the nature of workplace technology over the past century have resulted in an exponential shift in the nature of work activities, from physical labor to cognitive work. Modern work systems have many ...

Abstract	The increasing complexity of work systems and changes in the nature of workplace technology over the past century have resulted in an exponential shift in the nature of work activities, from physical labor to cognitive work. Modern work systems have many characteristics that make them cognitively complex: They can be highly interactive; comprised of multiple agents and artifacts; information may be limited and distributed across space and time; task goals are frequently ill-defined, conflicting, dynamic and emergent; planning may only be possible at general levels of abstraction or require adaptive solutions; some degree of proficiency or expertise is required; the stakes are often high; and uncertainty, time-constraints and stress are seldom absent. To complicate matters further, cognition in complex work settings is typically constrained by broader professional, organizational, and institutional practice and policy.- These features of cognitive work present significant challenges to scientific methodology and theory, and subsequent design of reliable interventions. Historically, philosophers and scientists have attempted to understand the mental activities experienced during cognitive work at multiple levels of analysis using divergent methods. Some have examined cognition at an associative, contextual, functional or holistic level, relying on naturalistic methods to understand the higher mental processes as they work in harmony during goal-directed behavior. Others have embraced experimental methods and favored internal over external validity, often reducing cognition to a psychology of fundamental acts, such as short-term memory access with millisecond shifts in attention. More recently, Macrocognition has evolved as a complementary paradigm.- Macrocognitive researchers have studied the cognitive functions and processes associated with skilled, adaptive, collaborative, and resilient cognitive work in the context of the aforementioned complexities of psychotechnical and sociotechnical work systems. Typically, this research has been carried out using cognitive task analytic techniques that draw on both naturalistic and (quasi-)experimental methods. The primary goals of research in Macrocognition are to better understand cognitive adaptations to complexity, to increase our theoretical understanding of the organism-environment relations by studying the mapping between cognitive work and real-world demands, and to promote use-inspired research capable of improving system performance
Keywords	Science (General) ; Psychology
Size	1 electronic resource (152 p.)
Publisher	Frontiers Media SA
Document type	Book ; Online
Note	English ; Open Access
HBZ-ID	HT020099613
ISBN	9782889454181 ; 2889454185
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article ; Online: Expression of the MSPDBL2 antigen in a discrete subset of

Freville, Aline / Stewart, Lindsay B / Tetteh, Kevin K A / Treeck, Moritz / Cortes, Alfred / Voss, Till S / Tarr, Sarah J / Baker, David A / Conway, David J

mBio

2024 , Page(s) e0314023

Abstract: The : Importance: Malaria parasites in the blood are remarkably variable, able to switch antigenic targets so they may survive within humans who have already developed specific immune responses. This is one of the challenges in developing vaccines ... ...

Abstract	The Importance: Malaria parasites in the blood are remarkably variable, able to switch antigenic targets so they may survive within humans who have already developed specific immune responses. This is one of the challenges in developing vaccines against malaria. MSPDBL2 is a target of naturally acquired immunity expressed in minority proportions of schizonts, the end stages of each 2-day replication cycle in red blood cells which contain merozoites prepared to invade new red blood cells. Results show that the proportion of schizonts expressing MSPDBL2 is positively controlled by the expression of the regulatory gametocyte development protein GDV1. It was previously known that expression of GDV1 leads to increased expression of AP2-G which causes parasites to switch to sexual development, so a surprising finding here is that MSPDBL2-positive parasites are mostly distinct from those that express AP2-G. This discrete antigenic subpopulation of mostly asexual parasites is regulated alongside sexually committed parasites, potentially enabling survival under stress conditions.
Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2557172-2
ISSN	2150-7511 ; 2161-2129
ISSN (online)	2150-7511
ISSN	2161-2129
DOI	10.1128/mbio.03140-23
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Article ; Online: Molecular epidemiology and population genomics of Plasmodium knowlesi.

Divis, Paul C S / Singh, Balbir / Conway, David J

Advances in parasitology

2021 Volume 113, Page(s) 191–223

Abstract: Molecular epidemiology has been central to uncovering P. knowlesi as an important cause of human malaria in Southeast Asia, and to understanding the complex nature of this zoonosis. Species-specific parasite detection and characterization of sequences ... ...

Abstract	Molecular epidemiology has been central to uncovering P. knowlesi as an important cause of human malaria in Southeast Asia, and to understanding the complex nature of this zoonosis. Species-specific parasite detection and characterization of sequences were vital to show that P. knowlesi was distinct from the human parasite species that had been presumed to cause all malaria. With established sensitive and specific molecular detection tools, surveys subsequently indicated the distribution of P. knowlesi infections in humans, wild primate reservoir host species, and mosquito vector species. The importance of studying P. knowlesi genetic polymorphism was indicated initially by analysing a few nuclear gene loci as well as the mitochondrial genome, and subsequently by multi-locus microsatellite analyses and whole-genome sequencing. Different human infections generally have unrelated P. knowlesi genotypes, acquired from the diverse local parasite reservoirs in macaques. However, individual human infections are usually less genetically complex than those of wild macaques which experience more frequent superinfection with different P. knowlesi genotypes. Multi-locus analyses have revealed deep population subdivisions within P. knowlesi, which are structured both geographically and in relation to different macaque reservoir host species. Simplified genotypic discrimination assays now enable efficient large-scale surveillance of the sympatric P. knowlesi subpopulations within Malaysian Borneo. The whole-genome sequence analyses have also identified loci under recent positive natural selection in the P. knowlesi genome, with evidence that different loci are affected in different populations. These provide a foundation to understand recent adaptation of the zoonotic parasite populations, and to track and interpret future changes as they emerge.
MeSH term(s)	Animals ; DNA, Protozoan ; Malaria/epidemiology ; Malaria/parasitology ; Metagenomics ; Molecular Epidemiology ; Plasmodium knowlesi/genetics
Chemical Substances	DNA, Protozoan
Language	English
Publishing date	2021-09-21
Publishing country	England
Document type	Journal Article
ZDB-ID	165-x
ISSN	2163-6079 ; 0065-308X
ISSN (online)	2163-6079
ISSN	0065-308X
DOI	10.1016/bs.apar.2021.08.003
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Article ; Online: Systematic overview of systematic reviews and clinical guidelines: assessment and prevention of behavioural risk factors associated with oral cancer to inform dental professionals in primary care dental practices.

Mathur, Sweta / Conway, David I / Macpherson, Lorna M D / Ross, Alastair J

Evidence-based dentistry

2022

Abstract: Aims/objectives Tobacco and alcohol are recognised as the major modifiable risk factors for oral cancer, the incidence of which is rising globally and predicted to increase. This paper aimed to: 1) appraise and synthesise best practice evidence for ... ...

Abstract	Aims/objectives Tobacco and alcohol are recognised as the major modifiable risk factors for oral cancer, the incidence of which is rising globally and predicted to increase. This paper aimed to: 1) appraise and synthesise best practice evidence for assessing the major behavioural risk factors for oral cancer and delivering behaviour change interventions (for example, advice, counselling, signposting/referral to preventive services); and 2) assess appropriateness for implementation by dental professionals in primary care.Methods A systematic overview was undertaken of systematic reviews and international clinical guidelines. This involved: systematically searching and collating the international literature on assessing oral cancer risk and delivering preventive interventions within primary care; quality appraising and assessing the risk of bias using validated tools; synthesising the evidence for best practice; and assessing application of key findings to the dental setting.Results and conclusions There is clear evidence for the effectiveness of a 'brief', in-person, motivational intervention for sustained tobacco abstinence or reduced alcohol consumption, following risk factor assessment. Evidence for combined behavioural interventions is lacking. There is no firm conclusion with regards to optimal duration of brief interventions (range 5-20 minutes). For tobacco users, longer (10-20 minutes) and intensive (more than 20 minutes, with follow-up visits) interventions are more effective in increasing quit rates compared to no intervention; very brief (less than five minutes) interventions in a single session show comparable effectiveness to the longer/more intensive interventions. For alcohol users, 10-15-minute multi-contact interventions were most effective, compared to no intervention or very brief (less than five minutes) intervention or intensive intervention; brief interventions of five-minute duration were equally effective. There is limited direct evidence from the dental practice setting (one high-quality systematic review relating to tobacco prevention and none relating to alcohol). Thus, very brief, or brief advice of up to five minutes, should be trialled for tobacco and alcohol respectively in a dental practice setting, after risk assessment tailored to patient motivational status. Exploring delivery by the dental team is supported, as effectiveness was generally independent of primary care provider.
Language	English
Publishing date	2022-03-07
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1457588-7
ISSN	1476-5446 ; 1462-0049
ISSN (online)	1476-5446
ISSN	1462-0049
DOI	10.1038/s41432-022-0235-1
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Article: Paths to a malaria vaccine illuminated by parasite genomics.

Conway, David J

Trends in genetics : TIG

2015 Volume 31, Issue 2, Page(s) 97–107

Abstract: More human death and disease is caused by malaria parasites than by all other eukaryotic pathogens combined. As early as the sequencing of the first human genome, malaria parasite genomics was prioritized to fuel the discovery of vaccine candidate ... ...

Abstract	More human death and disease is caused by malaria parasites than by all other eukaryotic pathogens combined. As early as the sequencing of the first human genome, malaria parasite genomics was prioritized to fuel the discovery of vaccine candidate antigens. This stimulated increased research on malaria, generating new understanding of the cellular and molecular mechanisms of infection and immunity. This review of recent developments illustrates how new approaches in parasite genomics, and increasingly large amounts of data from population studies, are helping to identify antigens that are promising lead targets. Although these results have been encouraging, effective discovery and characterization need to be coupled with more innovation and funding to translate findings into newly designed vaccine products for clinical trials.
MeSH term(s)	Animals ; Antigens, Protozoan/genetics ; Antigens, Protozoan/immunology ; Genomics ; Humans ; Malaria/prevention & control ; Malaria Vaccines ; Parasites/genetics ; Parasites/immunology ; Vaccination
Chemical Substances	Antigens, Protozoan ; Malaria Vaccines
Language	English
Publishing date	2015-01-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	619240-3
ISSN	1362-4555 ; 0168-9525 ; 0168-9479
ISSN (online)	1362-4555
ISSN	0168-9525 ; 0168-9479
DOI	10.1016/j.tig.2014.12.005
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Article: The Role of the Ophthalmic Genetics Multidisciplinary Team in the Management of Inherited Retinal Degenerations-A Case-Based Review.

Conway, Marcus P / Stephenson, Kirk A J / Zhu, Julia / Dockery, Adrian / Burke, Tomas / Turner, Jacqueline / Le, Francois Thai / O'Byrne, James J / Keegan, David J

Life (Basel, Switzerland)

2024 Volume 14, Issue 1

Abstract: 1) Background: Inherited retinal degenertions are rare conditions which may have a dramatic impact on the daily life of those affected and how they interact with their environment. Coordination of clinical services via an ophthalmic genetics ... ...

Abstract	(1) Background: Inherited retinal degenertions are rare conditions which may have a dramatic impact on the daily life of those affected and how they interact with their environment. Coordination of clinical services via an ophthalmic genetics multidisciplinary team (OG-MDT) allows better efficiency of time and resources to reach diagnoses and facilitate patient needs. (2) Methods: This clinical case series was conducted by a retrospective review of patient records for patients enrolled in the Target 5000 programme and managed by the OG-MDT, at the Mater Hospital Dublin, Ireland (
Language	English
Publishing date	2024-01-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life14010107
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